Observational studyLangenbeck's archives of surgery2019
Complex gastric surgery in Germany-is centralization beneficial? Observational study using national hospital discharge data.
Observational study in Langenbeck's archives of surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The Impact of Hospital Volume on Postoperative Outcomes for Esophagectomy and Gastrectomy: A Systematic Review and Meta-analysis.Annals of surgical oncology · 2026Pooled it
- Is the annual hospital volume associated with recurrence and chronic postoperative inguinal pain (CPIP) syndrome after inguinal hernia repair in laparo-endoscopic or open mesh technique (Lichtenstein)?Surgical endoscopy · 2025Article
- [Evidence for the extent and oncological benefit of lymphadenectomy in gastric cancer].Chirurgie (Heidelberg, Germany) · 2025Review
- How to measure quality of surgery as a component of multimodality treatment of gastric cancer.Annals of gastroenterological surgery · 2024Review
- Predictors and Significance of Readmission after Esophagogastric Surgery: A Nationwide Analysis.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2024Article
- TREATMENT OF GASTRIC CANCER ACCORDING TO THE COMPLEXITY OF THE HOSPITAL ONCOLOGY UNIT: ANALYSIS OF 33,774 PATIENTS OVER TWO DECADES.Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery · 2024Article
- [Robot-assisted visceral surgery in Germany : Analysis of the current status and trends of the last 5 years using data from the StuDoQ|Robotics registry].Chirurgie (Heidelberg, Germany) · 2023Article
- Influence of the centralizing gastric cancer surgery on the health-related quality of life in Brazil.Journal of gastrointestinal oncology · 2023Article
- Current Trends in Volume and Surgical Outcomes in Gastric Cancer.Journal of clinical medicine · 2023Review
- Gastrectomy for Cancer: A 15-Year Analysis of Real-World Data from the University of Athens.Medicina (Kaunas, Lithuania) · 2022Article
- Influence of hospital volume on bleeding after endoscopic submucosal dissection for early gastric cancer in Japan: a multicenter propensity score-matched analysis.Surgical endoscopy · 2022Article
- Pilonidal sinus disease on the rise: a one-third incidence increase in inpatients in 13 years with substantial regional variation in Germany.International journal of colorectal disease · 2021Article
- Hospital volume following major surgery for gastric cancer determines in-hospital mortality rate and failure to rescue: a nation-wide study based on German billing data (2009-2017).Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association · 2021Article
- Association of surgeon and hospital volume with postoperative mortality after total gastrectomy for gastric cancer: data from 71,307 Japanese patients collected from a nationwide web-based data entry system.Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association · 2021Article
- In-hospital mortality and failure to rescue following hepatobiliary surgery in Germany - a nationwide analysis.BMC surgery · 2020Article
- Article
- National Clinical Database (NCD) shows the trend for centralization of major surgery: Should it depend on hospital or surgeon volume ?Annals of gastroenterological surgery · 2019Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThis observational study explored the association between hospital volume and short-term outcome following gastric resections for non-bariatric indication, aiming to contribute to the discussion on centralization of complex visceral surgery in Germany.
methodsBased on complete national hospital discharge data from 2010 to 2015, the association between hospital volume and in-hospital mortality was evaluated according to volume quintiles and volume deciles. Case-mix differences regarding surgical indication, age, sex, and comorbidities were considered for risk adjustment. In addition, rates of major complications and failure to rescue were analyzed across hospital volume categories.
resultsInpatient episodes (72,528) with gastric resection were analyzed. Risk-adjusted mortality in patients treated in very low volume hospitals (median volume of 5 surgeries per year) was higher (12.0% [95% CI 11.4 to 12.5]) compared to those treated in very high volume hospitals (50 surgeries per year; 10.6% [10.0 to 11.1]). Failure to rescue patients with complications was 28.1% [27.0 to 29.3] in very low volume hospitals and 22.7% [21.6 to 23.8] in very high volume hospitals. Differences were similar within the subgroup of patients operated for gastric cancer.
conclusionsTreatment in very high volume hospitals is associated with a lower in-hospital mortality compared to treatment in very low volume hospitals. This effect seems to be determined by the ability to rescue patients who experience complications. As the observed benefit is only related to very high volumes, the results do not clearly indicate that centralization may improve short-term results substantially, unless a very high degree of centralization would be achieved. Possibly, further research focusing on other outcome measures, such as clinical processes or long-term results, might lead to divergent conclusions.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.